Historically, inpatient dermatology care has been a significant part of an otherwise predominantly outpatient-based speciality. Most dermatology units, in particular, the larger academic departments, used to have an inpatient facility occupying an entire floor or even several. Admissions for patients with recalcitrant chronic skin disorders were often prolonged. Patients were admitted for topical treatments, which would have been difficult and messy for patients to apply at home.

The pattern of inpatient care is undergoing change throughout the medical and surgical specialities. Patients no longer spend several weeks in the hospital after a myocardial infarction or hip replacement. The practice of dermatology has also been affected. The advent of effective and cosmetically more acceptable creams, phototherapy, and the introduction of oral immunosuppressive agents have broadened the scope of outpatient therapy. The acceptable end point of inpatient therapy has changed for many patients from clearance of skin disease to outpatient-manageable skin disease.

Accompanying these advances are changes in attitudes in society regarding personal appearance, tolerance of skin conditions, fear of cancer, expectations of therapy, and time to recovery from cutaneous disease. Attitudes and the insight of the medical profession are also changing. The consequences of skin disease on the psychologic well-being of the individual, employment status, and family circumstances are taken into consideration more often when choosing the appropriate therapy for a patient.

Most dermatology patients are not systemically unwell, and for these patients outpatient treatment is appropriate. Despite improved outpatient care and facilities, however, a core of patients remains for whom inpatient care is essential. Patients who have extensive skin disease or are physically frail or disabled may find it difficult to cope with an outpatient topical regimen. Topical treatment for skin disease can be time-consuming, complicated, and laborious. The elderly, in particular, may require inpatient care to ensure rapid resolution of their skin condition.

The skin is the body's most visible organ and plays a primary role in physical appearance and identity. Diseases of the skin are brought rapidly to the attention of the individual and often to others. The disfigurement caused by such conditions can result in the attribution of negative or denigrating qualities by society and by the patient, and this may lead to social isolation. How the patient copes with this assault on his or her psychologic well-being depends on his or her cultural attitudes, perceptions, and social support.<sup>5 Ginsburg I.H. The psychosocial impact of skin disease Dermatol Clin 1996 ;  14 : 473-483  [cross-ref]

Cliquez ici pour aller à la section Références</sup> An inpatient stay offers a period of intensive treatment in a haven away from the public eye and from the stresses of everyday life. It also provides the opportunity to educate patients about their condition and treatment as well as provide social support.

In the United States and the United Kingdom, dermatology inpatient services are being progressively rationalized. In some centers, specialist inpatient services have been lost completely. Financial and managerial containment are given as the prime reasons for this reduction in beds, not that alternative management strategies are more appropriate.<sup>10 Kirsner R.S., Yang D.G., Kerdel F.A. The changing status of dermatology: Inpatient dermatology at American academic dermatology programs J Am Acad Dermatol 1999 ;  40 (5 pt 1) : 755-757  [cross-ref]

Cliquez ici pour aller à la section Références</sup> Although advances in dermatologic therapy account for some reduction in the number of patients requiring admission, the scale of the bed loss suggests that the services available for patients are being compromised. Although both countries' health care systems are being affected by this rationalization, each has a distinct infrastructure.